{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T19:59:53Z","timestamp":1791575993933,"version":"4.3.4"},"reference-count":69,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Post-thrombotic syndrome (PTS) is a chronic complication of deep vein thrombosis (DVT). Given its impact on vascular health, understanding risk factors for the development of PTS, as well as conditions such as metabolic syndrome that may contribute to vascular inflammation, is crucial. Metabolic syndrome is a constellation of factors that increase cardiovascular disease risk, insulin resistance, diabetes mellitus (DM), and cerebrovascular disease. Despite the established connection between metabolic syndrome and venous thromboembolism (VTE), the association between metabolic syndrome and PTS has yet to be explored.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A literature search identified studies regarding PTS and metabolic syndrome and the individual components of metabolic syndrome. A specialist performed the search, and studies were identified through PubMed, Ovid Medline, and Cochrane in accordance with PRISMA guidelines. Search terms included \u201cpost-thrombotic syndrome\u201d and \u201cmetabolic syndrome\u201d as well as \u201cobesity,\u201d \u201chyperglycemia,\u201d \u201chypertension,\u201d \u201cdyslipidemia,\u201d and \u201cinsulin resistance.\u201d Two people independently screened articles and consolidated differences. Abstract-only studies, review articles, case studies, and conference abstracts were excluded. Case reports, literature reviews, and studies not discussing PTS were excluded. Prospective cohort, retrospective cohort, and case-control studies were included. All English-based studies that met inclusion criteria published before January 3rd, 2024, were included.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>281 articles were initially identified. After abstract and title screening, 16 articles underwent full-text review. Of the 16 articles that underwent review, nine were included in the final analysis. Among the selected articles, eight out of nine mentioned obesity as a risk factor for developing PTS, making it the most common component mentioned. Hypertension, diabetes mellitus, hyperlipidemia, and low high-density lipoprotein (HDL) followed in prevalence. There was no noted difference between inflammatory markers in patients with and without PTS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Metabolic syndrome and its components, individually and in association with PTS, are not commonly examined. Eight articles examined the association of obesity with the development of PTS. This review identified a strong association between obesity, particularly abdominal or visceral obesity, and the development of PTS. While the association between PTS and VTE is established, further research is needed to identify the role of metabolic syndrome in the development of PTS.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2025.1519534","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T05:28:59Z","timestamp":1743139739000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Association of post-thrombotic syndrome with metabolic syndrome and inflammation - a systematic review"],"prefix":"10.3389","volume":"16","author":[{"given":"Sara","family":"Alturky","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuf","family":"Ashfaq","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajit","family":"Elhance","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Barney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ishaq","family":"Wadiwala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna K.","family":"Hunter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khanh P.","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1182\/asheducation-2016.1.413","article-title":"The post-thrombotic syndrome","volume":"2016","author":"Kahn","year":"2016","journal-title":"Hematol Am Soc Hematol Educ Program"},{"key":"B2","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1186\/s42269-021-00685-w","article-title":"The cellular biology of atherosclerosis with atherosclerotic lesion classification and biomarkers","volume":"45","author":"Melaku","year":"2021","journal-title":"Bull Natl Res Cent"},{"key":"B3","article-title":"Metabolic syndrome","volume-title":"StatPearls","author":"Swarup","year":"2025"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1242\/dmm.001180","article-title":"A comprehensive definition for metabolic syndrome","volume":"2","author":"Huang","year":"2009","journal-title":"Dis Model Mech"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.5935\/abc.20180076","article-title":"Metabolic syndrome-related features in controlled and resistant hypertensive subjects","volume":"110","author":"Catharina","year":"2018","journal-title":"Arq Bras Cardiol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1089\/met.2018.0057","article-title":"Determining factors of arterial stiffness in subjects with metabolic syndrome","volume":"16","author":"Cozma","year":"2018","journal-title":"Metab Syndr Relat Disord"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.10828","article-title":"Venous thromboembolism\u2013a manifestation of the metabolic syndrome","volume":"92","author":"Ay","year":"2007","journal-title":"Haematologica"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-027545","article-title":"Relationship between metabolic syndrome and its components and cardiovascular disease in middle-aged and elderly Chinese population: a national cross-sectional survey","volume":"9","author":"Li","year":"2019","journal-title":"BMJ Open"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201907-518OC","article-title":"Metabolic syndrome increases risk of venous thromboembolism recurrence after acute pulmonary embolism","volume":"17","author":"Stewart","year":"2020","journal-title":"Ann Am Thorac Soc"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1080\/16078454.2019.1687144","article-title":"Inflammation in deep vein thrombosis: a therapeutic target","volume":"24","author":"Borgel","year":"2019","journal-title":"Hematology"},{"key":"B11","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1111\/j.1538-7836.2009.03294.x","article-title":"Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of post-thrombotic syndrome of the leg for use in clinical investigations: a recommendation for standardization","volume":"7","author":"Kahn","year":"2009","journal-title":"J Thromb Haemost"},{"key":"B12","doi-asserted-by":"publisher","first-page":"6938","DOI":"10.1038\/s41598-018-25135-y","article-title":"Elevated leptin and decreased adiponectin independently predict the post-thrombotic syndrome in obese and non-obese patients","volume":"8","author":"Mrozinska","year":"2018","journal-title":"Sci Rep"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2019.03.003","article-title":"Post-thrombotic syndrome: Short and long-term incidence and risk factors","volume":"177","author":"Ende-Verhaar","year":"2019","journal-title":"Thromb Res"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1111\/jth.12106","article-title":"Predictors of post-thrombotic syndrome in a population with a first deep vein thrombosis and no primary venous insufficiency","volume":"11","author":"Galanaud","year":"2013","journal-title":"J Thromb Haemost"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2015.05.019","article-title":"Visceral obesity, but not metabolic syndrome, is associated with the presence of post-thrombotic syndrome","volume":"136","author":"Rattazzi","year":"2015","journal-title":"Thromb Res"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2008.03180.x","article-title":"Risk factors for post-thrombotic syndrome in patients with a first deep venous thrombosis","volume":"6","author":"Tick","year":"2008","journal-title":"J Thromb Haemost"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1177\/00033197211070889","article-title":"Risk factors for post-thrombotic syndrome in patients with a first proximal deep venous thrombosis treated with direct oral anticoagulants","volume":"73","author":"Spiezia","year":"2022","journal-title":"Angiology"},{"key":"B18","article-title":"Body mass index is associated with the development of the post-thrombotic syndrome","volume":"89","author":"Ageno","year":"2003","journal-title":"Thromb Haemost"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.12659\/msm.901924","article-title":"Recurrent deep vein thrombosis after the first venous thromboembolism event: A single-institution experience","volume":"23","author":"Asim","year":"2017","journal-title":"Med Sci Monit"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1160\/TH08-08-0511","article-title":"Levels of inflammatory markers and the development of the post-thrombotic syndrome","volume":"101","author":"Shbaklo","year":"2009","journal-title":"Thromb Haemost"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/S0049-3848(09)70146-X","article-title":"Valvular dysfunction and venous obstruction in the post-thrombotic syndrome","author":"Vedantham","year":"2009","journal-title":"Thromb Res"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.121.318225","article-title":"Inflammation, infection and venous thromboembolism","volume":"128","author":"Colling","year":"2021","journal-title":"Circ Res"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1177\/1076029617727858","article-title":"Obesity paradox in patients with deep venous thrombosis","volume":"24","author":"El-Menyar","year":"2018","journal-title":"Clin Appl Thromb Hemost"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.4103\/2045-8932.93542","article-title":"Obesity and pulmonary arterial hypertension: Is adiponectin the molecular link between these conditions","volume":"1","author":"Summer","year":"2011","journal-title":"Pulm Circ"},{"key":"B25","doi-asserted-by":"publisher","first-page":"8095926","DOI":"10.1155\/2017\/8095926","article-title":"Adipokines: potential therapeutic targets for vascular dysfunction in type II diabetes mellitus and obesity","volume":"2017","author":"El Husseny","year":"2017","journal-title":"J Diabetes Res"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2006.02132.x","article-title":"The metabolic syndrome and the risk of venous thrombosis: a case\u2013control study","volume":"4","author":"Ageno","year":"2006","journal-title":"J Thromb Haemost"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa022157","article-title":"An association between atherosclerosis and venous thrombosis","volume":"348","author":"Prandoni","year":"2003","journal-title":"New Engl J Med"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.168.15.1678","article-title":"Overweight, obesity, and the risk of recurrent venous thromboembolism","volume":"168","author":"Eichinger","year":"2008","journal-title":"Arch Internal Med"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2006.10.006","article-title":"Obesity and thrombosis","volume":"33","author":"Darvall","year":"2007","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(93)92062-X","article-title":"Fibrinolytic activity, clotting factors, and long-term incidence of ischaemic heart disease in the Northwick Park Heart Study","volume":"342","author":"Meade","year":"1993","journal-title":"Lancet"},{"key":"B31","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1161\/CIRCULATIONAHA.107.709204","article-title":"Cardiovascular risk factors and venous thromboembolism: a meta-analysis","volume":"117","author":"Ageno","year":"2008","journal-title":"Circulation"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1997.03540320044033","article-title":"A prospective study of risk factors for pulmonary embolism in women","volume":"277","author":"Goldhaber","year":"1997","journal-title":"Jama"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/808353","article-title":"Pathophysiology of vascular remodeling in hypertension","volume":"2013","author":"Renna","year":"2013","journal-title":"Int J Hypertens"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2014.11.003","article-title":"Diabetes is associated with increased risk of venous thromboembolism: a systematic review and meta-analysis","volume":"135","author":"Bai","year":"2015","journal-title":"Thromb Res"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-005-1715-5","article-title":"The risk of venous thromboembolism is markedly elevated in patients with diabetes","volume":"48","author":"Petrauskiene","year":"2005","journal-title":"Diabetologia"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2010.03910.x","article-title":"Hyperglycemia: a prothrombotic factor","volume":"8","author":"Lemkes","year":"2010","journal-title":"J Thromb Haemost"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1016\/0049-3848(92)90068-L","article-title":"Coagulation and fibrinolytic system impairment in insulin dependent diabetes mellitus","volume":"67","author":"Carmassi","year":"1992","journal-title":"Thromb Res"},{"key":"B38","article-title":"Abnormalities of coagulation and fibrinolysis in insulin resistance. Evidence for a common antecedent","author":"Yudkin","year":"1999","journal-title":"Diabetes Care"},{"key":"B39","article-title":"Protein C deficiency in insulin-dependent diabetes: a hyperglycemia-related phenomenon","volume":"64","author":"Ceriello","year":"1990","journal-title":"Thromb Haemost"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.26.7.2181","article-title":"The platelet in diabetes: focus on prevention of ischemic events","volume":"26","author":"Colwell","year":"2003","journal-title":"Diabetes Care"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2004.00836.x","article-title":"Platelet activation in type 2 diabetes mellitus","volume":"2","author":"Ferroni","year":"2004","journal-title":"J Thromb Haemost"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1307","DOI":"10.1016\/S0735-1097(01)01555-8","article-title":"Blood thrombogenicity in type 2 diabetes mellitus patients is associated with glycemic control","volume":"38","author":"Osende","year":"2001","journal-title":"J Am Coll Cardiol"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1007\/BF00401055","article-title":"Coagulation activation in diabetes mellitus: the role of hyperglycaemia and therapeutic prospects","volume":"36","author":"Ceriello","year":"1993","journal-title":"Diabetologia"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1007\/s001250050594","article-title":"Glucose and insulin independently reduce the fibrinolytic potential of human vascular smooth muscle cells in culture","volume":"39","author":"Pandolfi","year":"1996","journal-title":"Diabetologia"},{"key":"B45","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/S0168-8227(99)00094-7","article-title":"Advanced glycation end products induce apoptosis and procoagulant activity in cultured human umbilical vein endothelial cells","volume":"46","author":"Min","year":"1999","journal-title":"Diabetes Res Clin Pract"},{"key":"B46","article-title":"Impaired endothelial antithrombotic activity following short-term interruption of continuous subcutaneous insulin infusion in type 1 diabetic patients","volume":"98","author":"Iorio","year":"2007","journal-title":"Thromb Haemost"},{"key":"B47","doi-asserted-by":"publisher","first-page":"21","DOI":"10.5853\/jos.2021.02831","article-title":"Hypertriglyceridemia: a neglected risk factor for ischemic stroke","volume":"24","author":"Liang","year":"2022","journal-title":"J Stroke"},{"key":"B48","doi-asserted-by":"publisher","first-page":"298","DOI":"10.17161\/kjm.vol15.17006","article-title":"Severe hypertriglyceridemia as a cause of aortic thrombus with peripheral embolic complications","volume":"15","author":"Safarova","year":"2022","journal-title":"Kans J Med"},{"key":"B49","article-title":"Plasma lipoproteins, hemostasis and thrombosis","volume":"86","author":"Griffin","year":"2001","journal-title":"Thromb Haemost"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab551","article-title":"Triglyceride-rich lipoproteins and their remnants: metabolic insights, role in atherosclerotic cardiovascular disease, and emerging therapeutic strategies-a consensus statement from the European Atherosclerosis Society","volume":"42","author":"Ginsberg","year":"2021","journal-title":"Eur Heart J"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.102.6.670","article-title":"Remnant lipoproteins induce proatherothrombogenic molecules in endothelial cells through a redox-sensitive mechanism","volume":"102","author":"Doi","year":"2000","journal-title":"Circulation"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.1016\/S0021-9150(99)00485-2","article-title":"Activated platelets in patients with severe hypertriglyceridemia: effects of triglyceride-lowering therapy","volume":"152","author":"Man","year":"2000","journal-title":"Atherosclerosis"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgad406","article-title":"Does elevated high-density lipoprotein cholesterol protect against cardiovascular disease","volume":"109","author":"Razavi","year":"2024","journal-title":"J Clin Endocrinol Metab"},{"key":"B54","doi-asserted-by":"publisher","first-page":"10760296221121282","DOI":"10.1177\/10760296221121282","article-title":"Association between blood lipid levels and lower extremity deep venous thrombosis: A population-based cohort study","volume":"28","author":"Huang","year":"2022","journal-title":"Clin Appl Thrombosis\/Hemost"},{"key":"B55","doi-asserted-by":"publisher","first-page":"732","DOI":"10.3390\/ijms21030732","article-title":"Advances in HDL: much more than lipid transporters","volume":"21","author":"Ben-Aicha","year":"2020","journal-title":"Int J Mol Sci"},{"key":"B56","doi-asserted-by":"publisher","first-page":"732","DOI":"10.3390\/ijms21030732","article-title":"High-density lipoprotein from patients with coronary heart disease loses anti-thrombotic effects on endothelial cells: impact on arterial thrombus formation","volume":"21","author":"Holy","year":"2020","journal-title":"Int J Mol Sci"},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvu137","article-title":"High-density lipoprotein as a modulator of platelet and coagulation responses","volume":"103","author":"Van der Stoep","year":"2014","journal-title":"Cardiovasc Res"},{"key":"B58","doi-asserted-by":"publisher","DOI":"10.1161\/01.RES.0000225982.01988.93","article-title":"Endothelial and antithrombotic actions of HDL","volume":"98","author":"Mineo","year":"2006","journal-title":"Circ Res"},{"key":"B59","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0148747","article-title":"Variable resistance to plasminogen activator initiated fibrinolysis for intermediate-risk pulmonary embolism","volume":"11","author":"Stubblefield","year":"2016","journal-title":"PloS One"},{"key":"B60","doi-asserted-by":"publisher","DOI":"10.1160\/TH14-06-0513","article-title":"Adipokines at the crossroad between obesity and cardiovascular disease","volume":"113","author":"Molica","year":"2015","journal-title":"Thromb Haemost"},{"key":"B61","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-021-00552-1","article-title":"Interplay between inflammation and thrombosis in cardiovascular pathology","volume":"18","author":"Stark","year":"2021","journal-title":"Nat Rev Cardiol"},{"key":"B62","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.048488","article-title":"Immunothrombotic dysregulation in COVID-19 pneumonia is associated with respiratory failure and coagulopathy","volume":"142","author":"Nicolai","year":"2020","journal-title":"Circulation"},{"key":"B63","article-title":"Factor Xa induces pro-inflammatory cytokine expression in RAW 264.7 macrophages via protease-activated receptor-2 activation","volume":"7","author":"Zuo","year":"2015","journal-title":"Am J Transl Res"},{"key":"B64","doi-asserted-by":"publisher","DOI":"10.1007\/s11239-023-02776-z","article-title":"The effect of rivaroxaban on biomarkers in blood and plasma: a review of preclinical and clinical evidence","volume":"55","author":"Schiffer","year":"2023","journal-title":"J Thromb Thrombol"},{"key":"B65","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9040923","article-title":"Prevention and management of the post-thrombotic syndrome","volume":"9","author":"Makedonov","year":"2020","journal-title":"J Clin Med"},{"key":"B66","doi-asserted-by":"publisher","DOI":"10.1055\/s-0036-1597765","article-title":"Medical treatment for postthrombotic syndrome","volume":"34","author":"Palacios","year":"2017","journal-title":"Semin Intervent Radiol"},{"key":"B67","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1080\/14779072.2021.1876563","article-title":"Surgical and non-surgical approaches in the management of lower limb post-thrombotic syndrome","volume":"19","author":"Machin","year":"2021","journal-title":"Expert Rev Cardiovasc Ther"},{"key":"B68","doi-asserted-by":"publisher","DOI":"10.1016\/j.suc.2017.11.005","article-title":"Advances in operative thrombectomy for lower extremity venous thrombosis","volume":"98","author":"Koopmann","year":"2018","journal-title":"Surg Clin North Am"},{"key":"B69","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61753-4","article-title":"Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial","volume":"379","author":"Enden","year":"2012","journal-title":"Lancet (London England)"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1519534\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T05:29:20Z","timestamp":1743139760000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1519534\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,28]]},"references-count":69,"alternative-id":["10.3389\/fimmu.2025.1519534"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2025.1519534","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,28]]},"article-number":"1519534"}}